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Shaf3y
etiology inflammatory bowel disease etiology Actually, two diseases Ulcerative colitis regional ileitis Crohns two diseases unknown << cause theories drugs manifestations Increase Non steroidal actually non steroidal etiology exacerbation
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Infection has been isolated << organism No organism has been isolated
disease females
Smoking Protective against ulcerative colitis Smoking is protective against ulcerative colitis
incidence of Crohns disease smoking protective against ulcerative colitis incidence of crohns disease House ulcerative colitis
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this is the first time I have seen a doctor advise by smoking this is the only case in the whole world that the smoking is the treatment Ulcerative colitis
ulcerative colitis pathology ulcerative colitis pathology ulcerative colitis pathology Ulcerative colitis disease gross pictures rectum rectum
rectum
rectum
sigmoid colon << rectum whole colon << rectum terminal ileum whole colon << rectum rectum sigmoid colon colon
terminal ileum
lesion
transverse
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loss of haustrations
fibrosis haustration
fibrosis
<<
fibrosis healing heal colon loss of haustration colon ulcerative colitis shortened colon
damage mucosa islands of normal cells proliferate proliferate Normal pseudo polyps
fibrosis
areas
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gross pictures microscopic pictures microscopic pictures only << inflammation limited to the mucosa infiltrated by inflammatory cells << Mucosa lymphocytes leucocytes With the inflammation limited to mucosa clinical pictures ulcerative colitis dysentery Colics, diarrhea, tenesmus, blood and mucous in the stool dysentery
attacks of dysentery remission and exacerbation dysentery remission and exacerbation attacks exacerbation Non steroidal anti inflammatory drugs emotions stress extra intestinal manifestations Ulcerative colitis ulcerative colitis extra intestinal manifestations attacks
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abdomen auto immune hepatitis Liver High incidence of cholangio carcinoma sclerosing cholangitis cholecystitis gall bladder Kidney oxlate stones kidney erythema nodusum pyoderma gangrenosum skin ankylosing spondylitis joints rheumatology Inflammatory bowel disease ankylosing spondylitis pictures manifestations ankle Knee arthritis G.I.T. manifestations Inflammatory bowel disease
G.I.T.
exacerbation exacerbation
rheumatology
intestinal manifestations complications inflammatory bowel disease complications Perforation Hemorrhage toxic megacolon cancer toxic megacolon paralytic ileus toxic megacolon small intestine paralytic ileus Large intestine toxic megacolon absolute constipation
disease
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anemia
CBC leucocytosis
cancer
investigations Colonoscopy inflammation Mucosa Barium lead pipe appearance shorten bowel pseudo polyps << Polyps Liver function test auto immune hepatitis spine X ray ankylosing spondylitis
Polyps
treatment in between
treatment treatment during the attack treatment during the attack Steroids steroids steroids
Oral
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toxic megacolon
fulminant colitis
5 aminosalicyclic acid 5 aminosalicyclic acid acetylsalicyclic acid aspirin 5 aminosalicyclic acid anti inflammatory sulphanoamide orally sulphonamide 5 aminosalicyclic acid carrier sulphonamide sulphasalazine
aspirin
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orally
In between attacks attacks sulphasalazine cortisone recent corticosteroids aminosalicyclic acid immune suppressant cyclosporine cyclophosphamide Azathioprine aminosalicyclic acid corticosteroids
cyclosporine
inflixmab
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And finally Surgical treatment surgery failed medical treatment fulminant colitis total coloectomy
fulminant colitis
Mucosa
mucosa
Ulcerative colitis
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Ulcerative colitis
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terminal ileum regional ileitis terminal ileum terminal ileum right sided colon Jejunum
sigmoid
terminal ileum
skip lesions affection skip patches gross pictures affected area gross pictures submucosa Mucosa inflammation the whole thickness inflammation the whole thickness limited to the mucosa only the whole thickness Inflammation
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serosa
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cobblestone arrangement the whole thickness the whole thickness inflammation Inflammation
Intestine
Perforation
the whole thickness inflammation intestine perforation regional ileitis fistula colon small intestines intestine Fistula vagina
Anal fistulas whole thickness microscopic examination the whole thickness of the intestine inflammation Non caseating
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appendicular mass
pseudo polyps
Investigations investigations Typical ulcerative colitis Barium Barium swallow terminal ileum terminal ileum
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ulcerative colitis
malabsoprtion
treatment Typical ulcerative colitis Typical Metrinidazole proliferation of bacteria surgical treatment failed medical treatment complications 10 routine surgery risk of cancer
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extensive fibrosis
bowel anastomosis
incision Loops of intestine Loops recurrence fistula skin skin wound wound fistula
Loops wound
wound
fistula
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adhesions
as regard
Ascites
ascites
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Lymphoma
tumor
chylous effusion milky white Rich in fat With Sudan III it becomes orange With Ether it becomes clear
Pericardial effusion chylous Hemorrhagic Hemorrhagic ascites Trauma Malignancy Bleeding tendency ( Hemorrhagic blood disease) Rupture aortic aneurysm T.B. Hemorrhagic RBCs LDH
exudates
transudate
osmotic pressure
osmotic hydrostatic
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Nephrotic
malnutrition
hydrostatic pressure
hydrostatic pressure heart Right sided heart failure Tricuspid stenosis, tricuspid regurge Constrictive pericarditis Portal hypertension
ascites
3 gram percentage
transudate protein content of the fluid 1016 specific gravity 1000 cells International << 200 LDH
exudates Peritoneum Inflammation exudates Permeability of the blood vessels exudates Septic peritonitis T.B. peritonitis Collagen diseases Pancreatitis Spontaneous bacterial peritonitis 3 gram percentage 1,016 Protein specific gravity 200 LDH 1,000 cells
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abdominal distention dyspnea ascites Lower limb edema dyspepsia symptoms of the cause
signs Local and general examination Local examination Inspection Abdominal distention Wide subcostal angles Divercuation of recti Shift of the umbilicus Umbilical hernia Caput medosa inspection
palpation organs by dipping masses Percussion flanks dullness shifting dullness transmitted thrill
succession splash
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succession splash
comatosed
comatosed comatosed
auscultation
Percussion
palpation
Anyway inspection
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examination
apex
right sided pleural effusion diaphragm pleura Peritoneum anatomical opening right side only right side ascites right sided pleural effusion congested neck veins diaphragm ascites venous return
ascites
treatment of ascites treatment of the underlying cause liver cell failure treatment of ascites
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ascites
treatment dose not reduce mortality for symptomatic reasons only treatment ascites dyspnea treatment of ascites complications treatment treatment
treatment ascites treatment bed rest Load bed rest Metabolic demand
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fluid
80 Naturally Already
Which means
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fluid restriction severe massive ascites fluid restriction hepatorenal syndrome Kidney fluid restriction severe cases umbilical hernia
diet
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Hypokalemia
sudden diuresis
gradual
Lasilactone
hepatic encephalopathy
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lasix
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plasma
albumin
500
albumin albumin Tapping para centesis severe respiratory distress Umbilical hernia about to rupture failed other measures ascetic fluid
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tapping
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rupture
Umbilicus fluids
Ascites prevent ascites blood vessel Peritoneum According to the pressure gradient ascites Pressure pressure gradient abdomen ascites abdomen pressure transudation
peritoneal sac
blood vessel
According to pressure gradient Pressure massive ascites abdomen Pressure blood vessel
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fluids albumin blood vessel osmotic pressure albumin blood vessels fluids retain
refractory ascites ascites not responding to medical treatment refractory ascites Not responding to medical treatment refractory ascites ascites not responding to medical treatment Spontaneous bacterial peritonitis T.B. peritonitis Malignancy Liver end stage liver disease lasix hyponateremia severe hyponateremia diuretics Urine hyponateremia glomerular filtrate
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hyponateremia
effective
diuresis
effective diuresis
bleeding varices
Mannitol blood vessel Lumen blood volume varices bleeding varices This is dangerous Osmotic diuresis mannitol varices
mannitol
refractory ascites Hyponateremia varices severe hypoalbuminemia end stage liver disease
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ascites
ascites
Intra venous
ascetic fluid
fluid
D.I.C.
vena cava
Shunt
One way valve << Shunt vena cava ascetic fluid D.I.C. sepsis hypervolemia addition
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Liver transplant Liver transplant TIPSS Transjugular intrahepatic portosystemic stent shunting
Globus hystericus
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reassurance only
just reassurance chest pain of esophageal origin corkscrew esophagus Esophageal spasm angina pain pain Nitrates calcium channel blockers
GERD
duodenum
stomach
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erophagia
Non ulcerative dyspepsia peptic ulcer features features cholecystitis features Non ulcerative dyspepsia functional vomiting functional vomiting femlaes Iam talking about females females females << Females
psychogenic problem
androgen
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Once
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No way
irritable bowel syndrome disease Irritable bowel syndrome disease community functional gastrointestinal disorders functional gastrointestinal disorders irritable bowel syndrome Irritable bowel syndrome irritable bowel syndrome
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etiology theories psychological is more common in type A personality << irritable bowel syndrome Irritable anxious future planners
Low vegatables and fruit in the diet diet fibers irritable bowel infection has been isolated << organism allergy to certain types of food
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abdomen
stool
spastic stool
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Tension headache type A personality investigations Stool analysis colonoscopy to exclude other lesions
irritable bowel criteria criteria irritable bowel syndrome criteria abdominal pain abdominal pain defecation pain hard stool consistency change bowel frequency change irritable bowel syndrome criteria abdomen disease
soft
dysentery abdominal pain defecation pain bowel frequency change bowel consistency change dysentery criteria criteria criteria
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congenital
Coronaries
coronaries
research center
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Motility of the bowel bran bran colon spastic distention peristalsis peristalsis spastic waves
waves distention of the colon bran colon diarrhea amytriptyline laxative constipation serotonin serotonin reuptake inhibitor Serotonin reuptake inhibitor Peristalsis waves normalization constipation laxative serotonin reuptake inhibitors
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distention
Seroxat
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as regard irritable bowel syndrome functional gastrointestinal disorders colorectal polyps MCQs << paralytic ileus intestinal obstruction Haematemesis
Haematemesis
definition of haematemesis haematemesis
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haematemesis haematemesis Vomiting of a blood due to a lesion proximal to the ligament of Teritz Vomiting of a blood due to a lesion proximal to the ligament of teritz
haematemesis fresh blood melanemesis coffee ground rectum melena fresh blood
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Mallory weiss Longitudinal tear in the mucosa Longitudinal tear in the mucosa vomiting esophagus stomach stomach Peptic ulcer Fundal varices
haematemesis
duodenum
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causes of false haematemesis false haematemesis respiratory tract Upper problem bleeding nose sinusitis blood vomiting false haematemesis
haematemesis ABC airway obstruction airway ventilator wide bore cannula lab blood matching saline fresh blood Omeprazole K medical tradition vitamin K endoscopy band ligation vaso pressin vasoconstricting drugs tube Sangstaken surgical treatment peptic ulcer Omeprazole
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somatostatin
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G.I.T. 2013 23 31
www.facebook.com/dr.tafreegh
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